DEAR MAYO CLINIC: A friend just underwent a rotator cuff repair and is recovering well. But I was wondering, what if you get to a point where repairing the tear is no longer an option? Is there anything else that can help with pain and improve shoulder function?  And what about stem cells or this platelet-rich plasma I hear about?

ANSWER: Shoulder pain, weakness and loss of range of motion can keep you from the activities you need and love to do, whether it's lifting boxes on the job, putting away dishes in the kitchen or hitting that pickleball serve.

Wear and tear, injury, certain medical conditions, and age can take a toll on shoulder function. Oftentimes, surgery can be avoided, with many people responding well to nonoperative treatments, such as physical therapy or injections, to decrease their pain and improve the use of their shoulder. Sometimes, surgery to repair the torn tendons may be necessary.

But other times, the condition of your shoulder has advanced beyond those options. In the past, this may have resulted in chronic pain and debility. Now, there are new treatments designed especially for more advanced shoulder issues.

Inserting a balloon or patch for stabilization

When a rotator cuff tear is so severe that it can't be repaired, your orthopedic surgeon may use a subacromial balloon spacer. This small device is inserted into the space where the damaged rotator cuff lies using minimally invasive arthroscopic surgical techniques. Once in place, the device is inflated with saline to cushion and stabilize the joint. The balloon typically dissolves within six to 12 months. 

Alternatively, your surgeon may implant a special donated tissue graft to cover or "patch" the top of the ball part of your shoulder joint. This procedure, called a tuberoplasty, acts similarly to the balloon to provide a cushion in place of the rotator cuff. 

After surgery, a physical therapist will help you retrain your muscles to move the shoulder using more optimal mechanics. Recovery from these procedures tends to be faster since the tendons don't need to heal as they would in traditional rotator cuff surgery. You can return to your daily activities with improved function, range of motion and less pain.

Using 3D printing for shoulder replacement 

Reverse shoulder replacement is another surgical option for treating patients with severe arthritis, irreparable rotator cuff tears or other shoulder damage. By using specially designed implants, your surgeon can change the mechanics of the shoulder to allow other muscles to move it.

Since no shoulder is the same, how closely the replacement implant fits your shoulder's anatomy and how the implant is placed play key roles in the success of a reverse shoulder replacement. Your surgeon is able to choose from metal and plastic implants that are available in a few different shapes and a range of sizes. A 3D-printed model of your shoulder can help your orthopedic surgeon precisely place the implant. 

The process begins with a CT scan before surgery to create a 3D model of your shoulder on a computer. This allows your surgeon to see how the implant should be placed, how to preserve as much bone as possible and how to identify the best way to secure the implant. A 3D guide is printed that duplicates the template from the computer.

During surgery, your surgeon places the 3D guide on the bone so the implant can be placed precisely as planned.

3D modeling also helps your surgeon determine if you need a customized implant.

Creating a customized implant

In most cases, your surgeon can choose a standard implant that will give you the shoulder function you need. But for some patients, their anatomy or bone damage won't allow a standard implant to fit appropriately. An implant that doesn't fit well can fail, leading to more surgery. 

In these cases, an implant can be created to precisely fit a patient. Using a computer-generated 3D model, the custom implant designed for the patient is printed using the same materials as a standard implant. While this is only being used in special cases, it may become the standard in time.

Robotic surgery

While robotics have been used in many other surgeries, including hip and knee replacements, for some time, the use of robotic surgery in the shoulder is just beginning. The technology is new and specialized.  

As mentioned before, putting the implants in the right position is important, and the robot helps your surgeon do this exactly as planned. During a shoulder replacement, your surgeon can use a robot to help reshape the socket precisely to get the best placement and position of the implant to help provide you with the optimal outcome. Although this technology is new, it may become the future of shoulder replacement.   

Stem cells and biological treatments

Stem cells and other therapies such as platelet-rich plasma are new and promising treatment options known as regenerative medicine. These are often called orthobiologics as they are made from your own body’s substances. Stem cells are cells that have the potential to heal and transform into more specialized cells such as muscle, tendon or bone cells. They are harvested from tissues in the body such as blood or fat.  Platelet-rich plasma takes blood from your arm and separates out the red blood cells, keeping healing and anti-inflammatory factors.  

When injected, these therapies try to stimulate your own body's cells to promote a healing response in the tissue. They have shown potential benefit in treating pain from arthritis, helping heal and recover from tendinopathies or muscle strains, and improving healing after surgery. 

While both treatments show promise in helping to decrease pain and potentially improve healing, they unfortunately will not regrow cartilage or tendons, and they will not "cure" arthritis. But, hopefully, we can get there in the future.  

Though promising, the data is still inconclusive, and further studies are needed to determine the best uses for them. Additionally, since they are considered experimental, they are rarely covered by insurance and can be very costly.  

Wider spectrum of treatments customized for you

There are new options to provide a wide spectrum of treatments for patients with advanced shoulder issues. Having multiple options allows your orthopedic surgeon to choose the one that targets your specific issues to achieve the best outcome. 

Scott Kuzma, M.D., Orthopedics & Orthopedic Surgery and Sports Medicine, Mayo Clinic Health System, La Crosseand Onalaska, Wisconsin

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Over two years ago, a devastating hip condition and a misdiagnosis threatened to sideline a young high school basketball player for good. But thanks to advanced medical expertise and innovation at Mayo Clinic, the 16-year-old prep star in North Carolina is back in the game — stronger, more determined and inspiring others with his comeback story.

Jason Howland has his story.

Watch: Mayo Clinic restores hoop dreams for teen athlete

Journalists: Broadcast-quality video (2:44) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Watch him on the court, and it’s clear that 16-year-old Roman Solheim loves playing basketball.

"I love the competitive nature, just competing and having fun with my guys," he says.

A 6-6 high school sophomore in Greensboro, North Carolina, Roman has high hopes for the future. "I want to go to a D1 school, preferably a high major, and become an engineer," he says.

But three years ago, those hoop dreams were nearly deflated by a subtle hitch in his step.

"We couldn't figure out anything because he, being Roman, didn't say too much. He didn't really complain about it," says Kristie Solheim, Roman's mother.

"I was just limping, not moving the same way that I usually do," Roman says.

"He went through some therapy, and he started playing again, but his limping was more pronounced at that point. And then it started to be painful," says Brent Solheim, Roman's father.

Roman's doctors diagnosed him with avascular necrosis, a lack of blood supply to the bone. "There's not a good treatment for it. He has to stop playing all sports to preserve his hip as long as possible, and he's looking at a hip replacement in 10 years," Brent says.

"It's crazy. It just wrecked my world, basically," Roman says.

"We said, 'We're going to get a second opinion at Mayo.' And that's what we did," Brent says.

A multidisciplinary team of experts at Mayo Clinic in Rochester, Minnesota, quickly determined the true cause of Roman's limp and hip pain.

"They said I had chondroblastoma, which is a benign bone tumor on my femoral head," Roman says.

"The tumor was inside his femoral head, the ball in the socket joint. It is a rare tumor, but especially for younger patients with open growth plates, it's something that we see commonly here," says Dr. Emmanouil Grigoriou, a Mayo Clinic hip preservation surgeon.

Dr. Grigoriou performed the surgery to remove Roman's tumor. "We were able to surgically and safely dislocate the hip so we can actually take the ball out of the socket, so we can see exactly the tumor, remove it in its entirety, and then put in extra bone — just to let it and help it heal — and then put everything back in place," he says.

A key component of surgical planning and the procedure itself was a 3D-printed replica of Roman's ball-and-socket joint created by the Anatomic Modeling Unit at Mayo Clinic.

"The green is Roman's tumor, and this is a model of his very specific hip with his very specific tumor," says Dr. Grigoriou as he displays the replica of Roman's femoral head.

Two years after the tumor was removed, Roman is back on the court and better than ever. "I can jump a lot higher now," Roman says.

"It was amazing to see him back on the court after, you know, being told he couldn't play again," Brent says.

"We're very proud. He's been through a lot. He's very brave," Kristie says.

"Anything is possible. I came from being told I would never play again to playing at a very high level," Roman says. "You can do way more than what you think."

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Paul Rhee suffered a stroke that resulted in weakness and spasticity in his right arm and leg. His son, Dr. Peter Rhee, spent the next decade perfecting his research that led to the intricate hand nerve surgery that restored his father’s mobility and function.

When Paul Rhee had a stroke in 2015, it changed everything. He lost movement in his arm, endured painful spasms, and withdrew from daily life because of the unwanted attention his bent arm caused. Simple joys — social gatherings, attending church, spending time with family, holding a fishing rod — slipped away. 

For his son, Peter Rhee, D.O., M.S., a hand and microvascular surgeon at Mayo Clinic, the experience was both deeply personal and professionally motivating. “Fishing was something my dad and I always dreamed of sharing across generations. After his stroke, even that was gone,” Dr. Rhee recalls. “It took away part of who he was.”

Fishing was more than just a pastime. For Dr. Rhee, it was symbolic of family and continuity. 

That loss became a powerful motivator. Dr. Rhee was determined not just to help his father, but to develop a treatment that could restore hope for patients everywhere who live with spasticity following brain or spinal cord injury.

The Mayo difference

What Dr. Rhee achieved could only happen at Mayo Clinic.

Spasticity occurs when the brain or spinal cord can’t properly control signals to the muscles, causing them to contract uncontrollably and often creating deforming postures. Traditional treatments for spasticity focus on surgically altering the muscles, but Dr. Rhee identified the nerves as the root problem. 

Developing a new surgical procedure was no small task. It required years of research and the support of a broad, multidisciplinary team at Mayo Clinic. Physical medicine physicians, anesthesiologists, rehabilitation specialists, therapists, and scientists in the Motion Analysis Lab all played crucial roles in bringing Dr. Rhee’s vision to life.

“I don’t think it would have been possible, even if I had the will as the surgeon, without the supporting cast, the resources, the support — everyone buying into the fact that no matter how complicated it is, we can do it together,” Dr. Rhee explains.

Mayo’s Motion Analysis Lab is nationally accredited and one of fewer than 20 labs of its kind in the U.S., it is also one of only two that evaluates both children and adults. Here, patients aren’t studied through static images like X-rays or MRIs. Instead, they are evaluated while moving, allowing experts to see exactly when and how their muscles misfire or fail.

Patients often arrive without a clear diagnosis, only knowing that something isn’t working the way it should. Staff in the lab spend three to four hours with each patient, using advanced motion capture and electromyography (EMG) sensors to measure how the brain communicates with the muscles. Some sensors are placed on the skin for larger muscles, while fine wire electrodes, as thin as a human hair, are used for deeper or smaller muscles. These tools provide precise, real-time data about how the muscles respond to nerve signals.

“By using dynamic EMG, we can see how the muscles are firing compared to how the arm moves,” says Dr. Rhee. “That helps us plan the surgery with a level of accuracy that isn’t possible in most academic medical centers in the world. With every patient visit, I had more ideas about how to treat patients like my father,” he says.  

This level of integration between science and surgery is rare. “The only way you can get this kind of information is through the collaboration of a physician and a scientist,” says Kenton Kaufman, Ph.D., Director, Motion Analysis Lab. “We can see how the upper extremity muscles are functioning while the person is moving. And these types of studies are not done anywhere else but at Mayo Clinic.”

The Motion Analysis Lab doesn’t just inform surgery; the team collects data during surgeries themselves. The lab is able to study human muscle physiology in-vivo, something not done anywhere else in the world. This research has already led to publications in top-ranked medical journals and continues to advance the understanding of spasticity and its treatment.

“Dr. Rhee’s procedures not only restore function, but also quality of life,” adds Dr. Kaufman. “Patients sense the hope that they’ll have a better outcome, because of the time we take to gather the data needed to achieve the best possible surgical results.”

From a single patient to nationwide impact

Dr. Rhee, the sole physician qualified to conduct Paul Rhee's surgery, obtained institutional authorization following a thorough review by the Mayo Clinic Ethics Committee. In December 2022, and again in March 2023, Dr. Rhee performed his new surgical procedure on his father. 

The results were profound. Paul regained movement in his arm, was able to relax muscles that had been locked in place for years, and found the confidence to reengage with his community. Most importantly, he could once again hold a fishing rod — a milestone that symbolized freedom and independence.

“After the surgery, he no longer feared people staring at his arm and was able to reconnect with his community,” Dr. Rhee reflects.

The same procedure is now changing lives for patients across the country. Dr. Rhee and his team perform two to three of these complex upper extremity reconstructions each week, often lasting up to 14 hours and involving the entire limb from shoulder to fingertip. Mayo Clinic is one of fewer than 10 centers nationwide where this type of surgery is available, and the team performs more spasticity-related reconstructions than any other center in the U.S.

Dr. Rhee also trains fellows in hand and reconstructive surgery, ensuring that the next generation of surgeons can carry this innovation forward. Over the past six years, nearly 30 physicians have learned the procedure under his guidance. “Following the Mayo brothers’ tradition of sharing expertise, we are expanding access to this surgery worldwide,” he notes.

His colleague, Kitty Wu, M.D., who trained under Dr. Rhee and joined Mayo’s staff in 2023, is expanding the technique further to treat lower extremity spasticity. “Our procedures are restoring hope for patients who thought they had forever lost the function of their limb,” Dr. Wu says. “In some cases, the procedure even prevents permanent disability.”

“Dr. Wu trained at Mayo and expanded on our unique techniques. Together, we offer comprehensive upper and lower extremity reconstructive surgery to adult and pediatric patients,” Dr. Rhee adds.  

For Dr. Rhee, the lessons extend beyond the operating room. “I ask patients what they want to do most that they can’t do now. For many in the Midwest, it’s fishing — something close to my heart as well. When I can say, ‘I believe we can get you back to fishing, holding a grandchild or simply moving without pain’ it builds trust and hope. And that’s what Mayo is about.”

Category of one

What happened for Paul Rhee is much more than a single success story. It represents the best of Mayo Clinic: a seamless integration of practice, research and education; teams of experts working together; and a patient-first mission that drives innovation.

Thanks to this pioneering work, Paul can once again fish with his son and grandchildren, an experience the family thought was lost forever. Thanks to the pioneering spirit of our staff, stories like Paul’s remind us why Mayo Clinic remains a place where innovation, teamwork and patient-first care change lives every day.

Watch: Dr. Rhee and his father before and after the surgery

 Journalists: Video (2:17) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network."

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Bicycling is a great way to stay active and enjoy the outdoors. Whether you're a recreational rider or a daily commuter, it's important to protect your hands and wrists. Dr. Sanj Kakar, a Mayo Clinic orthopedic surgeon specializing in hands and wrists, shares practical tips to prevent injuries while biking.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:08) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Whether you're a pro or biking for fun, there are common injuries all cyclists might experience.

"The first one is a traumatic injury if somebody falls off a bike," says Dr. Kakar. 

Common breaks from traumatic injury include wrist fractures.

"We also see overuse-type injuries. So, for example, we see patients where they're pressing on the brakes for too long, squeezing hard, putting pressure on their palm, and their hands sometimes fall asleep — called numbness and tingling," Dr. Kakar says.

He says it could be carpal tunnel syndrome, a condition you don't want to ignore.

"If you have numbness and tingling in the fingers, it is something I wouldn't ignore because if you have carpal tunnel, we worry about that," Dr. Kakar explains.

The numbness and tingling can become permanent and result in the loss of muscle strength

Prevent bike injuries

"There are simple preventive measures you can take," says Dr. Kakar. "Having thicker grips so you're not squeezing as hard can also help. Bike gloves help as well and sometimes puts your wrist in a better position than putting pressure on your palm."

You can't always avoid an accident, but you can make your ride safer by always wearing a bike helmet.

Related posts:

• Mayo Clinic Minute: Keeping kids safe outside during summer play
• Mayo Clinic Minute: Ultrasound therapy for pain following carpal tunnel surgery

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Dr. Nathan LeBrasseur, director of the Robert and Arlene Kogod Center on Aging at Mayo Clinic, says it's never too late to get moving, even if you're an older adult.

Watch: The Mayo Clinic Minute

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Starting a workout program or being physically active takes motivation and commitment. The key is to start slowly and do something you take pleasure in.

"If you hate swimming, don't try to start to become a swimmer. But (if) you enjoy dancing or other activities (such as) gardening, those are forms of activity that once you engage in, you increase your consistency and compliance that will have the most health benefits," says Dr. LeBrasseur.

Being active can build muscle strength and improve cognitive and cardiovascular health.

"Three percent, or 30 minutes a day, of our waking hours, if we commit that to physical activity, will have huge benefits," explains Dr. LeBrasseur.

And for those young at heart, the Centers for Disease Control and Prevention recommends 150 minutes of moderate exercise a week.

"As we get older, dedicating time, purposeful time, to getting some form of aerobic exercise or endurance exercise, like walking or cycling or swimming, and also getting some form of strength training is critically important," says Dr. LeBrasseur.

Tips to get started and stick with a workout plan:

• Research workout routines.
• Schedule your workouts.
• Find an exercise buddy.
• Be consistent.

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In 2020, the National Collegiate Athletics Association (NCAA) approved women's wrestling as an emerging sport. Since then, athletes, coaches and other leaders have recognized that its policies need to differ from those of men's wrestling.

Wrestling is a sport that divides competitors into weight classes or weight categories; how much athletes weigh at the time of competition is a vital component to determining the most equal opponent. Wrestlers at the high school and collegiate levels are required to complete a pre-season weight certification — consisting of a hydration test, a weigh-in and a body composition assessment — to determine the wrestler's minimal wrestling weight, which then dictates the lowest weight class they will be eligible to compete in.

When creating the initial weight policy for women's wrestling, the NCAA set the body fat percentage to determine an athlete's minimal wrestling weight at 12%. However, recent research led by Andrew Jagim, Ph.D., the director of Sports Medicine Research at Mayo Clinic, has determined that a 17% body fat percentage may be a more reasonable and safer alternative to use.

"There has been scrutiny and concern among sports medicine professionals that the 12% value may be too low." Dr. Jagim says. "It could predispose female wrestlers to disordered eating patterns, frequent weight cycling and risks of certain health conditions such as the Female Athlete Triad."

Dr. Jagim says the Female Athlete Triad is a condition that consists of a trio of health issues including menstrual dysfunction, hormonal imbalance and reductions in bone health.

Here, Dr. Jagim answers questions about his findings.

What has your research shown about the current state of determining minimum weight for female wrestlers?

Values calculated during the preseason weight certification are established to discourage excessive weight cutting and frequent weight cycling throughout the season. Previously, a body fat percentage threshold of 12% was used for female wrestlers, which meant that a wrestler could reduce their weight to a point that would equate to a body fat percentage of 12%. Our work, however, has identified that 95% of current female wrestlers have a body fat percentage above 17%, which indicates that not a lot of female wrestlers are engaging in excessive weight cutting to achieve the lower body fat percentage of 12%. Our work on this topic has helped provide evidence to the National Collegiate Athletics Association to encourage revision of their policies and adopt a new threshold of 17% for collegiate wrestlers. In the spring of 2025, I will be presenting our research to the National Federation of State High School Associations and recommending a threshold of 19% for high school wrestlers.

Why is it important to change how the minimum weight for these athletes is calculated?

It is important to continually evaluate sports policies to help promote a safe sporting environment for athletes. With the emergence and rapid growth of women's wrestling, we are learning more about the sport and subsequently have more information to make more informed decisions regarding safety policies. While it doesn't appear to be a major issue yet, as the sport continues to grow, we will likely see wrestlers face more pressure to gain a competitive advantage — and in wrestling, that often means trying to compete in the lowest allowable weight class. If the 12% body fat threshold were to remain in existence, we may see an increase in female wrestlers engaging in excessive weight-cutting practices that could significantly increase health risks and lead to various negative outcomes such as the Female Athlete Triad and an increased risk of injury and illnesses.

What can athletes, coaches and parents do better to protect the athletes' health?

Some of the most important and effective things that can be done to protect the athletes' health is to follow evidence-based guidelines regarding optimal performance strategies. In brief, this means:

• Getting at least eight hours of sleep per night as frequently as possible.
• Following sports-specific fueling strategies (i.e., eating enough overall calories to support the high level of training and eating enough of the right macro and micronutrients to support the growth, development and recovery needs of a highly active young athlete).
• Properly managing the training loads of an athlete, meaning trying to avoid excessive amounts of high-intensity training year-round and making sure to incorporate planned periods of rest or active recovery.

From a wrestling-specific perspective, it's important to find the optimal weight and body fat percentage that allows the wrestler to feel their best, reduces the pressure of having to frequently cut weight throughout the season, and allows them to eat a healthy diet that provides the essential nutrients that their bodies require.

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In this Mayo Clinic Minute, Dr. Kenton Kaufman, the W. Hall Wendel Jr. Musculoskeletal Research Professor who is behind the study, explains the findings and why it's never too late to improve your balance.

Watch: The Mayo Clinic Minute

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Aging can be a balancing act, and according to Mayo Clinic research, your ability to balance on one leg can be a meaningful measure of aging.

"This was a study looking at markers of aging in older adults," explains Dr. Kaufman, senior author of the study and director of the Motion Analysis Laboratory at Mayo Clinic. 

Forty healthy, independent, community-dwelling people over age 50 underwent various tasks known to be markers of aging, including balance.

"We were comparing different markers of aging and trying to see which one was the most predictive of declines with aging," says Dr. Kaufman.

Standing on one leg

He says, if someone can stand with all their weight on one leg for 30 seconds, they're doing very well.

"Balance is complicated. It involves many different systems. It involves your vision, your vestibular system, your somatosensory system and your neuromuscular system. All those have to work in coordinated fashion to keep you on one leg," says Dr. Kaufman.

All of those systems deteriorate with age and increase the risk of falls. The good news is it's never too late to improve your balance, it just takes practice.

"The important message is to try it at home. It's very simple, easy to do. It's quick. If you are unable to stand on your leg for five seconds, at least five seconds, then you're at risk of falling," says Dr. Kaufman.

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"Interestingly, it's the fourth busiest holiday for hand injuries," says Dr. Sanj Kakar, a Mayo Clinic orthopedic hand and wrist surgeon.

Dr. Kakar says almost one-third of those Halloween hand injuries are among kids ages 10 to 14. And most of them happen when people are carving pumpkins.

Watch: The Mayo Clinic Minute

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Please courtesy: "Mayo Clinic News Network." Read the script.

"It's primarily stabbing injuries where the knife may slip, and, so, they can cut things like tendons, which are the ropes that help move your hands," Dr. Kakar says. "But they can also break bones, and also they can burn themselves, as well, with candles."

But Dr. Kakar says most of the injuries are avoidable.

"A lot of people might just go to the kitchen and grab a sharp knife. But there's good studies out there showing that actual pumpkin-specific carving knives [are safer], [because] actually the force needed to injure yourself, is higher if you use one of those than if you use a standard knife," he says. "So I would use a pumpkin carving kit, No. 1."

No. 2, Dr. Kakar says, is to let kids handle designing the jack-o'-lantern, but make sure adults do all of the carving.

And No. 3, make sure you're always supporting the pumpkin with your noncutting hand.

"So if you're right-handed, use your left hand to support the pumpkin and carve from the top down as opposed to the bottom up," Dr. Kakar says. "It's very easy for the knife to slip and go into your hand."

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You're playing tag with your kids, hitting a fast tennis return shot, landing after a gymnastics vault, evading a football tackle or jumping off a rock onto the beach. Suddenly, you feel a pop in your knee, then immediate pain followed by swelling. You may have just injured or torn your anterior cruciate ligament, or ACL.

How an ACL tear can happen

The ACL is a tough band of tissue that lies within your knee and provides front-to-back and rotational stability. When there's too much force through the ligament — especially from a noncontact action — it can burst. This type of force happens during movements such as:

• Landing awkwardly from a jump.
• Making a quick change of direction.
• Pivoting with your foot planted.
• Receiving a blow to the knee, like when being tackled.
• Stopping suddenly.

The factors that can lead to an ACL injury include:

• Athletic activity — Participating in sports, such as soccer, football, basketball, gymnastics or downhill skiing.
• Conditioning — Poor conditioning increases the risk of injury.
• Field surface — Playing on artificial turf compared to other surfaces like grass since your foot can become more securely planted.
• Gender — Women are more susceptible to ACL tears due to knee anatomy, muscle strength and hormonal influence.
• Sports gear — Wearing footwear that doesn't fit properly or using poorly maintained sports equipment increases the risk of injury.

What to do after an ACL injury

As soon as possible after the injury, you can reduce pain and swelling by following the R.I.C.E. method at home.

The R.I.C.E. method includes:

• Rest — Promote healing and pain by limiting weight bearing on your knee.
• Ice — Try to ice your knee for 20 minutes at least every two hours when you're awake.
• Compression — Wrap your knee with an elastic bandage or compression wrap.
• Elevation — Use pillows to prop up your knee.

If you're concerned about the extent of the injury, consult with an orthopedic specialist, who may order an MRI, which is the gold standard for diagnosing ACL issues. Surgery is often necessary, especially if you want to return to higher-impact activities.

Treatment for an ACL injury

If the orthopedic specialist recommends surgery, you'll work with an orthopedic surgeon to reconstruct your ACL. During surgery, your surgeon strives to recreate your anatomy as closely as possible. Typically, you'll go home the same day as the surgery even if the meniscus, a shock-absorbing pad of cartilage, also has been damaged. Your surgeon will repair both at the same time.

Following an ACL reconstruction, you'll begin walking and undergo physical therapy right away to regain range of motion and strength. The goal is for you to return to regular activity as soon as possible.

If you need more complex surgery, such as both ACL and meniscus repair, you typically won't be able to put full weight on the injured leg for four to six weeks. However, you'll still undergo physical therapy that focuses on range of motion and strength.

Watch a video on what to expect during and after surgery:

At about three months, your physical therapy team may start you on activity- or sports-specific exercises such as jogging or dribbling a ball. Part of your postoperative care may include working out on an anti-gravity treadmill that lets you practice running while putting no weight on your legs. Physical therapists also may conduct functional testing, including the hop test, to ensure that both legs have the same strength and range of motion. They also will gradually increase the impact on your healing leg.

By about nine months, you should be able to return to unrestricted competition or higher-impact activity.

Take action to avoid an ACL tear

Researchers are still determining who may be predisposed to ACL tears. However, you can take action to help prevent an ACL injury. Lower your risk of injury by taking steps to:

• Increase stability by strengthening your core.
• Learn and practice good form and mechanics for your sport.
• Work on overall leg strength, including your quadriceps, hamstrings and glutes.

Next steps:

• Find an orthopedic or sports medicine specialist near you.
• Learn more about ACL injuries in teen athletes.
• Read more about ACL injuries and treatment.

Watch a video on ACL tear treatment and risk reduction:

Douglas Bartels, M.D., is an orthopedic surgeon in Orthopedics and Sports Medicine in Eau Claire, Wisconsin.

This article first published on the Mayo Clinic Health System blog.

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Stylish shoes can add the finishing touch to an outfit and help you feel like you're putting your best foot forward. But those dressy shoes might not be the best for your feet — especially your toes.

Shoes that are narrow, tight, pointed or high-heeled can push the tip of your big toes toward and over your smaller toes, causing bunions.

Bunions are bulging, bony bumps at the base of your big toes. As the angle of your big toe worsens, the joint may become red, swollen and ache. Pain can occur in the joint and under the ball of your foot.

Smaller bunions, called bunionettes or tailor's bunions, can form on the outer part of your foot at the base of your fifth toe.

While your choice of shoes can contribute to bunions, other factors include:

• Arthritis
• Deformity at birth
• Inherited foot anatomy
• Injury

Learn the steps to take to manage the pain of bunions or bunionettes.

First step: Relief without surgery

Typically, experiencing pain and not being able to wear stylish shoes or walk long distances lead people to seek care, usually with a podiatrist or orthopedic specialist.

The first line of treatment is nonsurgical:

• Evaluate your shoe choices and select bunion-friendly options. Choose shoes with a wider toe box — no pointy toes — that give your toes room to spread out and relieve the pressure on the bunion.
• Give your shoes the "press" test to ensure there's a space between the tip of your big toe and the end of the shoe.
• Take over-the-counter medications like acetaminophen, ibuprofen or naproxen or apply ice to relieve pain and swelling.
• Try toe spacers that separate your toes and bunion guards that provide padding between the shoe and your aching joint.

Second step: Consider surgery

Keep in mind that bunion surgery isn't cosmetic surgery. The angle of your bunion may be severe, but surgery is not typically recommended unless it's giving you consistent pain that interferes with your daily activities.

If your orthopedic specialist determines that surgery is your best option for pain relief, you'll undergo imaging that helps your surgeon choose the best surgical procedure and technique.

The surgery may involve one or more procedures. These might be:

• Joining the bones of your big toe joint permanently.
• Realigning one or more bones in your forefoot to a more normal position to correct the abnormal angle of your big toe joint.
• Removing swollen tissue from around the big toe joint.
• Straightening your big toe by removing part of the bone.

Third step: Recovery

Each person's bunion surgery is different and so is their recovery. Be sure to talk with your surgeon about what to expect during the healing process. You may be able to walk on your foot right after the procedure, or you may need to avoid bearing weight on it while it heals. You may not be fully recovered for weeks or months.

After surgery, the best way to prevent a bunion from reforming is to wear properly fitted shoes that conform to the shape of your feet without squeezing or pressing on any part of your foot.

Next steps:

• Check out an FAQ on foot care and health.
• Learn more about bunions and bunionettes.
• Read how to determine your foot arch type.
• If you're a runner, check out how to get the best fit in your running shoes.

Taylor Beahrs, M.D., specializes in orthopedic surgery and sports medicine, including foot and ankle surgery, in Mankato, Minnesota.

This article first published on the Mayo Clinic Health System blog.

The post How to step up to manage bunions appeared first on Mayo Clinic News Network.